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<div class="outer"> |
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<div class="container"> |
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<h1>Create an Account</h1> |
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<form class="form"> |
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<div class="full-name form-group"> |
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<label for="name">Name</label> |
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<input type="text" id="name" placeholder="Name" class="input"/> |
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</div> |
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<div class="row name-split split"> |
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<div class="col-lg-6 form-group"> |
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<label for="first_name">First Name</label> |
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<input type="text" name="fist_name" id="first_name" placeholder="First Name" class="input"/> |
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</div> |
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<div class="col-lg-6 form-group"> |
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<label for="last_name">Last Name</label> |
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<input type="text" name="last_name" id="last_name" placeholder="Last Name" class="input"/> |
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</div> |
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</div> |
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<div class="full-email form-group"> |
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<label for="full_email">Email</label> |
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<input type="email" id="full_email" placeholder="Email" class="input"/> |
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</div> |
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<div class="row email-split split"> |
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<div class="col-lg-6 form-group"> |
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<label for="email">Email</label> |
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<input type="email" name="email" id="email" placeholder="Email" class="input"/> |
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</div> |
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<div class="col-lg-6 form-group"> |
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<label for="username">Username</label> |
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<input type="text" name="username" id="username" placeholder="Username" class="input"/> |
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</div> |
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</div> |
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<div class="full-password form-group"> |
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<label for="full_password">Password</label> |
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<input type="password" id="full_password" placeholder="Password" class="input"/> |
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</div> |
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<div class="row password-split split"> |
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<div class="col-lg-6 form-group"> |
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<label for="password">Password</label> |
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<input type="password" name="password" id="password" placeholder="Password" class="input"/> |
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</div> |
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<div class="col-lg-6 form-group"> |
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<label for="password_confirm">Confirm Password</label> |
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<input type="password" name="password_confirm" id="password_confirm" placeholder="Confirm Password" class="input"/> |
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</div> |
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</div> |
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<input type="submit" class="submit" value="Create Account"/> |
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</form> |
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<p class="well-sm text-center"> |
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By signing up, you agree to our <a href="#">Terms & Conditions</a> |
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</p> |
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</div> |
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</div> |